<script language="JavaScript" type="text/javascript">
	<!--
	function register()
	{
  	document.registration_form.submit() ;
	}
	-->
</script><div id="body">
<div id="reg">
<?=$this->validation->error_string; ?>
<?php echo form_open('onlineaide/user_registration', array('name'=>'registration_form', 'id'=>'registration_form'), array('word'=>$aCaptcha['word'] )); ?>
<table id="reg_table" cellpadding="5px" cellspacing="0" border="0"">
<tr>
	<td align="left"><label for="username_regf" style="color:#FFFFFF;">Username: </label></td>
	<td align="center"><?php 
		if(isset($_POST['username_regf']))
   			{$myvalue = $this->validation->username_regf;}
		else{$myvalue = "";}
		echo form_input(array('id'=>'username_regf', 'name'=>'username_regf' , 'class'=>'text', 'size'=>20, 'maxlength'=>15, 'value'=>$myvalue)); ?></td>
	<td align="left" class="reminder">* required</td></div>
</tr>
<tr>
	<td align="left"><label for="password_regf" style="color:#FFFFFF;">Password: </label></td>
	<td align="center"><?= form_password(array('id'=>'password_regf', 'name'=>'password_regf' , 'class'=>'text', 'size'=>20, 'maxlength'=>20)); ?></td>
	<td align="left" class="reminder">* required</td>
</tr>
<tr>
	<td align="left"><label for="conf_password_regf" style="color:#FFFFFF;">Confirm Password: </label></td>
	<td align="center"><?= form_password(array('id'=>'conf_password_regf', 'name'=>'conf_password_regf' , 'class'=>'text', 'size'=>20, 'maxlength'=>20)); ?></td>
	<td align="left" class="reminder">* required</td>
</tr>
<tr>
	<td align="left"><label for="first_name_regf" style="color:#FFFFFF;">First Name: </label></td>
	<td align="center"><?php 
		if(isset($_POST['first_name_regf']))
   			{$myvalue = $this->validation->first_name_regf;}
		else{$myvalue = "";}
		echo form_input(array('id'=>'first_name_regf', 'name'=>'first_name_regf' , 'class'=>'text', 'size'=>20, 'maxlength'=>20, 'value'=>$myvalue)); ?></td>
	<td align="right" class="reminder">* required</td>
</tr>
<tr>
	<td align="left"><label for="middle_name_regf" style="color:#FFFFFF;">Middle Name: </label></td>
	<td align="center"><?php 
		if(isset($_POST['middle_name_regf']))
   			{$myvalue = $this->validation->middle_name_regf;}
		else{$myvalue = "";}
		echo form_input(array('id'=>'middle_name_regf', 'name'=>'middle_name_regf' , 'class'=>'text', 'size'=>20, 'maxlength'=>20, 'value'=>$myvalue)); ?></td>
	<td align="right" class="reminder"></td>
</tr>
<tr>
	<td align="left"><label for="last_name_regf" style="color:#FFFFFF;">Last Name: </label></td>
	<td align="center"><?php 
		if(isset($_POST['last_name_regf']))
   			{$myvalue = $this->validation->last_name_regf;}
		else{$myvalue = "";}
		echo form_input(array('id'=>'last_name_regf', 'name'=>'last_name_regf' , 'class'=>'text', 'size'=>20, 'maxlength'=>20, 'value'=>$myvalue)); ?></td>
	<td align="right" class="reminder">* required</td>
</tr>
<tr>
	<td align="left"><label for="address_regf" style="color:#FFFFFF;">Address: </label></td>
	<td align="center"><?php 
		if(isset($_POST['address_regf']))
   			{$myvalue = $this->validation->address_regf;}
		else{$myvalue = "";}
		echo form_input(array('id'=>'address_regf', 'name'=>'address_regf' , 'class'=>'text', 'size'=>20, 'maxlength'=>100, 'value'=>$myvalue)); ?></td>
	<td align="right" class="reminder"></td>
</tr>
<tr>
	<td align="left"><label for="email_regf" style="color:#FFFFFF;">Email: </label></td>
	<td align="center"><?php 
		if(isset($_POST['email_regf']))
   			{$myvalue = $this->validation->email_regf;}
		else{$myvalue = "";}
		echo form_input(array('id'=>'email_regf', 'name'=>'email_regf' , 'class'=>'text', 'size'=>20, 'maxlength'=>50, 'value'=>$myvalue)); ?></td>
	<td align="right" class="reminder">* required</td>
</tr>
<tr>
	<td align="left"><label for="contact_number_regf" style="color:#FFFFFF;">Contact Number: </label></td>
	<td align="center"><?php 
		if(isset($_POST['contact_number_regf']))
   			{$myvalue = $this->validation->contact_number_regf;}
		else{$myvalue = "";}
		echo form_input(array('id'=>'contact_number_regf', 'name'=>'contact_number_regf' , 'class'=>'text', 'size'=>20, 'maxlength'=>20, 'value'=>$myvalue)); ?></td>
	<td align="right" class="reminder"></td>
</tr>
<tr>
	<td> <?=$aCaptcha['image']?><br/></td>
	<td><?php echo form_input(array('id'=>'captcha', 'name'=>'captcha' , 'class'=>'text', 'size'=>20, 'maxlength'=>20)); ?></td><td align="right" class="reminder">* required</td>
</tr>
<tr>  <td colspan="3" align="center"><a href="javascript:register()" id="reg_link">Register</a></td></tr>
</table>
</form>
</div>

